More Than 20 Million U.S. Children Lack Sufficient Access to Health Care

Report sets out strategies for improving access to pediatric care

Children’s Health Fund (CHF), a national health care nonprofit dedicated to medically underserved children across the U.S., has released a new report titled, “Unfinished Business: More Than 20 Million Children in the U.S. Still Lack Sufficient Access to Essential Health Care.”

CHF analyses show that 20.3 million U.S. children—28% of the pediatric population under the age of 18 years—are without adequate health care. This is based on three considerations: 1) children who are uninsured, 2) those who are insured, but do not receive regular primary care, and 3) children who are publicly insured, connected to primary care, but do not receive essential and timely specialty care. CHF’s conclusions were derived from research into national health data sets as well as its own clinical experiences and programmatic data.

“While children’s health care has experienced increased and significant attention in recent years, our analyses show there is still a long way to go before we can claim that all U.S. children have access to the care they need. There has been a persistent misconception that simply providing health insurance is the same as assuring effective access to appropriate health care. It isn’t,” said Dr. Irwin Redlener, co-founder and president of Children’s Health Fund, and the paper’s lead author. “Although Medicaid, the Children’s Health Insurance Program (CHIP), and most recently the Affordable Care Act (ACA) insure more children than ever before, millions of kids are not getting the care they need.”

CHF’s report offers several actionable recommendations for policy-makers as the U.S. prepares for a new presidential administration in 2017. Distinguishing between financial and nonfinancial barriers, the authors endorse strategies for improving access to pediatric health care. Regarding the former, these include reducing or eliminating costly copayments and increasing reimbursement rates for providers treating underserved communities.

For nonfinancial barriers, CHF suggests increasing incentives that encourage health care providers to practice in poor communities; improving health care access through telehealth, mobile clinics, and school-based health care opportunities; addressing transportation barriers; promoting health literacy; and helping parents with limited English proficiency.

“Conversations about health care in this country tend to focus on adults, because that’s where we spend the most money,” notes co-author and CHF Chief Medical Officer Dr. Delaney Gracy. “Part of the point we hope to make is that prevention and early interventions for children can decrease burden of disease and impact later on, as they grow into a generation of healthier adults. The national cost of common illnesses related to poverty and poor medical access, like asthma and obesity, is several billions of dollars annually.”

CHF’s research points out that of the 20.3 million children—28% of all U.S. children—who are not receiving adequate care, more than 80% are insured but not receiving optimal care. Based on analyses of National Health Interview Survey data from 2014 and 2015, the report asserts that 3.3 million U.S. children are uninsured while 10.3 million do not have adequate access to primary care, in spite of having some form of insurance. In addition, CHF extrapolated findings from its own programs in New York City to estimate that 6.7 million children—9% of all U.S. children—on Medicaid or CHIP who have access to primary care are still not receiving the specialty care they need to be healthy.

“Without losing sight of the improvements we’ve made as a country—including at least 6 million more insured children since 1997—the purpose of this white paper is to raise awareness about the work that remains,” said CHF Executive Director Dennis Walto. “We have come a long way—but key programs that contributed to improved children’s health care like CHIP and the ACA are not limitless. CHIP funding is set to expire in 2017; the ACA will doubtless be subject to revisions. It is our mission to promote the extension and expansion of these initiatives as we move towards a truly universal health care system for all children.” Walto continued, “It is critical, at this point in our efforts to ensure health care for all children, that we not forfeit gains made—we have come far, we owe it to our children to push through the last mile.”

Dr. Redlener, a professor of pediatrics and health policy and management at Columbia University in New York, added, “the consequences of failing to ensure unencumbered access to quality health care are enormous. Unattended health conditions can interfere with the ability to learn in school. Assuring that all children grow up healthy and educated is essential to America’s future.”

Sources: CHF; November 21, 2016; Unfinished Business Report, November 2016.